(A) The summary court, upon retaining jurisdiction of an offense involving one or more victims, reasonably must attempt to notify each victim of his right to:

1. (1) be present and participate in all hearings;
2. (2) be represented by counsel;
3. (3) pursue civil remedies; and
4. (4) submit an oral or written victim impact statement, or both, for consideration by the summary court judge at the disposition proceeding.

(B) The summary court must provide to each victim who wishes to make a written victim impact statement a form that solicits pertinent information regarding the offense, including:

1. (1) the victim's personal information and supplementary contact information;
2. (2) an itemized list of the victim's economic loss and recovery from any insurance policy or any other source;
3. (3) details of physical or psychological injuries, or both, including their seriousness and permanence;
4. (4) identification of psychological services requested or obtained by the victim;
5. (5) a description of any changes in the victim's personal welfare or family relationships; and
6. (6) any other information the victim believes to be important and pertinent.